Infections of the Genital Tract Flashcards Preview

ESA 4 - Reproductive System > Infections of the Genital Tract > Flashcards

Flashcards in Infections of the Genital Tract Deck (152):
1

What does the term sexually transmitted infections include? 

Both symptomatic and asymptomatic cases, where sexual activity is the principle mode of transmission

2

What does the term sexually transmitted disease include? 

Symptomatic cases only

3

Give two examples of infections where sexual activity is a possible mode of transmission, but also have other routes of transmission? 

  • BBV
  • Sexual transmission of intestinal pathogens

 

4

What intestinal pathogens can be transmitted sexually?

  • Salmonella
  • Shigella
  • Giardia
  • Entamoeba

 

5

What groups are at risk of sexually transmitted infections? 

  • Young people
  • Certain ethnic groups
  • Low socio-economic status groups

 

6

Why are young people at an increased risk of STIs?

Because they are more sexually active

7

What do the groups at risk of STIs relate to? 

Specific aspects of sexual behaviour

8

What specific aspects of sexual behaviour can cause an increased risk of STIs? 

  • Age at first sexual intercourse
  • Number of partners
  • Sexual orientation
  • Unsafe sexual activity

 

9

What is happening to the incidence of STIs? 

It is increasing

10

Why may the incidence of STIs be increasing? 

  • Increased transmission
  • Increased GUM attendence
  • Improved diagnostic methods, including screening programmes

 

11

Why may there be an increased transmission of STIs? 

  • Changing sexual and social behaviour
  • Increased density and mobility of populations

 

12

Why may increased GUM attendance give the impression that the incidence of STIs is increasing?

Leads to more diagnoses being made

13

Why is GUM attendance increasing? 

  • Decreased stigma
  • Greater public, medical, and national awareness

 

14

How have diagnostic methods improved regarding STIs?

Better equipment makes it easier to detect organisms

15

What factors contribute to the burden of STIs? 

  • Can be both acute and chronic/replapsing infections
  • Stigma
  • May be consequent pathologies
  • Disseminated infectins
  • Transmission to fetus/neonate

 

16

What does stigma regarding STIs have an impact on? 

  • Diagnosis 
  • Tracing

 

17

What consequent pathologies can arise from STIs? 

  • Pelvic inflammatory disease and infertility 
  • Reproductive tract cancers

 

18

Which STI in particular can cause reproductive tract cancers? 

Papilloma viruses

19

What do disseminated STIs involve?

Multiple organ systems, over years and decades

20

How can STIs be diagnosed? 

  • Patients present with genital lesions/problems to GP or GUM clinic
  • Clinician notes non-genital clinical features suggestive of STI
  • Asymptomatic cases may be detected with contact tracing or screening

 

21

What genital problems may a patient present to a GP or GUM clinic with? 

  • Ulcers 
  • Vesicles
  • Warts
  • Urethral discharge or pain
  • Vaginal discharge

22

When may a clinical note non-genital clinical features that are suggestive of STI?

If there are clues from the history

 

23

What may non-genital clinical features of an STI suggest?

Disseminated disease

24

What does contact tracing and screening for STIs look for? 

High risk people

25

What is the purpose of identifying asymptomatic cases by contact tracing and screening? 

Reduce risk of complications and transmission

26

How are STIs managed? 

  • Treatment with antibiotics
  • Contact tracing
  • Education

 

 

27

What is preferable when giving antibiotics in STIs? 

  • Single dose or short course
  • Delivered at time of diagnosis
  • Oral drug

 

28

Are co-infections common with STIs? 

Yes

29

What is it important to do due to the fact that co-infection with STIs are common? 

  • Screen
  • Consider empiric treatment for other STIs

 

30

What happens to treatment for some STIs? 

It changes over time

31

Why does the treatment for some STIs change over time? 

  • Drug availability
  • New formulations
  • Resistance

 

32

What is the purpose of contact tracing? 

Patient and public health management

33

What education should be delivered regarding STIs? 

  • Sexual health education
  • Advice on contraception
  • Detailed instruction on practice and need for safer sex

 

34

How many types of human papillomaviruses are there? 

>100, but small number of particular concern

35

What kind of virus is HPV?

DNA virus 

36

What % of young adults will experience HPV in their life? 

˜4%

37

What are the most common types of HPV causing STIs? 

HPV 6 and 11

38

What do HPV 6 and 11 cause? 

  • Cutaneous, mucosal, and anogenital warts
  • Benign, painles, verrucous epithelial or mucosal outgrowths that can be on;
    • Penis
    • Vulva
    • Vagina
    • Urethra
    • Cervix
    • Perianal skin 

39

What are the high risk type of HPV?

16 and 18 

40

What are HPV 16 and 18 associated with? 

Cervical (<70%) and anogenital cancer

41

Why is cervical cancer a major public health concern? 

  • 2500 cases of cervical cancer in 2012
  • Most common cancer in women 15-34
  • Large % of cases are potentially preventable

 

42

What % of cervical cancers are associated with HPV 16 or 18?

<70%

43

How is a diagnosis of HPV infection made? 

  • People likely to come forward with warts
  • Clinical diagnosis
  • Biopsy and genome analysis
  • Hybrid capture

 

44

What is the purpose of biopsy and genome capture in HPV viruses? 

Gives specific nucleic viral section, so can tell if warts are caused by papilloma

45

How is HPV treated? 

  • No treatment
  • Topical podophyllin
  • Cryotherapy
  • Intralesional interferon
  • Imiquimoid
  • Surgery

 

46

Why is HPV often given no treatment? 

Spontaneous resolution in 70% of cases in 1 year, and 90% in 2 years

47

How is HPV screened for? 

  • Cervical Pap smear cytology
  • Colposcopy and acetowhite test
  • Cervical swab

 

48

What does a cervical Pap smear cytology check for? 

Early evidence of cervical cancer

49

What happens in a cervical swab for HPV? 

HPV hybrid capture

50

What % of 20-24 year olds are positive for HPV hybrid capture? 

40%

51

What are the types of HPV vaccine? 

  • Cervarix
  • Gardisil 

 

52

What does Cervarix protect against? 

HPV 16 and 18

53

Why is cervarix no longer used in the UK? 

There was a large backlash against decision to just protect against 2 HPV types when could protect against more

54

What does Gardasil protect against? 

HPV 6, 11, 16, and 18

55

When was Gardasil introduced in the UK? 

2011

56

Who is the Gardasil vaccine offered to? 

Girls 12-13

57

How many doses of Gardasil are given? 

2

58

How effective is Gardasil? 

99% effective in preventing HPV 16 and 18 related cervical abnormaltiies in those not already infected

59

What is the most commonly detected STI? 

Chlamydia Trichomatis

60

What kind of pathogen is C. Trachomatis?

An obligate intracellular bacterium 

61

What is the diagnostic result of C. Trachomatis being an obligate intracellular bacterium? 

  • Can't grow on gram stains
  • Can't grow on agar media

 

62

What serotypes of C. Trachomatis cause non-specific genital chlamydial infections? 

D-K

63

What are different serotypes of C. Trachomatis associated with? 

Different conditions

64

What does C. Trachomatis infection cause in males? 

  • Urethritis
  • Epididymitis
  • Prostatitis
  • Proctitis

 

65

What does C. Trachomatis infection cause in females? 

  • Urethritis
  • Cervicitis
  • Salpingitis
  • Perihepatitis

 

66

What is salpingitis? 

Inflammation of the fallopian tubes 

67

What are the symptoms of salpingitis? 

Abdominal pain and referred shoulder pain from the liver

68

What does ocular inoculation of C. Trachomatis cause? 

Conjunctivitis

69

What does neonatal infection of C. Trachomatis cause? 

  • Inclusion conjunctivitis
  • Pneumonia

 

70

How is a C. Trachomatis infection diagnosed? 

  • Endocervical and urethral swabs
  • 1st void urine

 

71

What is performed on samples taken for investigation of C. Trachomatis infection? 

Nucleic acid amplification tests

 

 

72

How is a neonatal infection if C. Trachomatis detected? 

Conjunctival swab, followed by nucleic acid amplification tests

 

 

73

How is a C. Trachomatis infection treated? 

  • Doxycycline or azithromycin, can be given as a single large dose
  • Erythromycin in children

 

74

Is C. Trachomatis ever asymptomatic? 

Yes, many cases are, especially in women 

75

What does the fact that many causes of C. Trachomatis are asymptomatic have implications for? 

Transmission

76

How many cases of C. Trachomatis are diagnosed each year? 

>200,000, nearly half of all STIs

77

What % of C. Trachomatis cases are diagnosed at GUM clinics? 

50%

78

What % of C. Trachomatis cases are diagnosed from the chlamydia screening programme? 

50%

79

Who does the chlamydia screening programme target? 

Sexually active under 25's 

80

How is the chlamydia screening programme carried out? 

Urine (M&F) or swab (F), followed by nucleic acid amplification test 

81

What is chlamydia sometimes screened for in conjunction with? 

N. gonorrhoea

82

What are the symptoms of primary genital herpes? 

  • Extensive and painful genital ulceration 
  • Dysuria
  • Inguinal lymphadenopathy
  • Fever

 

83

What is the inguinal lymphadenopathy caused by in primary genital herpes? 

Local inflammation

 

84

What is primary genital herpes usually associated with? 

HSV2

85

What does HSV1 usually cause? 

Cold sores

86

How severe is recurrent genital herpes? 

Can be asymptomatic to moderate

87

What allows recurrent genital herpes to occur? 

Due to latent infection in dorsal root ganglia

88

How is a diagnosis of genital herpes made? 

PCT of vesicle fluid and/or ulcer base

89

How is genital herpes treated? 

Aciclovir

90

When is aciclovir prophylaxis given? 

When a patient has frequent recurrences, to try and reduce frequency and severity 

91

What reduces the risk of transmission of genital herpes? 

Barrier contraception 

92

What kind of pathogen is Neisseria gonorrheae? 

Gram negative intracellular diplococcus

93

What does N. gonorrhoae cause in males?

  • Urethritis and painful discharge
  • Epididymitis
  • Prostatitis
    Proctitis
  • Pharyngitis
  • May have referred pain to testes or prostate (felt in perineum) 

 

94

In whom does N. gonorrhoae cause proctitis and pharyngitis? 

In MSM

95

What does N. gonorrhoeae cause in women? 

  • Asymptomatic
  • Endocervicitis
  • Urethritis
  • PID

 

96

What does PID lead to? 

Inflammation of the fallopian tubes, which causes them to block and may lead to infertility 

97

What can disseminated gonococcal infection lead to?

  • Bacteriaemia
  • Skin and joint lesions

 

98

How is a gonorrhoea diagnosis made? 

  • Swab from urethra, cervix, throat, or rectum, or urine sample
  • Gram stain of pus or normally sterile site

 

99

What is the diagnostic difficulty with N. gonorrheae? 

Fastidious organism requiring special media

100

How is gonorrhoea treated? 

Intramuscular ceftrixone 

101

Why must gonorrhoea be treated with IM ceftrixone? 

Due to increasing resistance to many other agents 

102

What is the increasing antibiotic resistance of N. gonorrhoae partially due to? 

Movement of strains between different parts of the world, particularly the Middle East

103

What happens to all patients with gonorrhoea? 

They are treated (and tested) for chlamydia with azithromycin 

104

What is the addition benefit of treating gonorrhoea patients with azithromycin for chlamydia? 

May prevent emergence of resistance to cephalosporins

105

What is the aetiological agent of syphilis? 

Treponema pallidum 

106

 Who are most cases of sphilis found in? 

MSM

107

What is the first stage of a syphilis infection? 

Indurated, painless ulcer called chancre

108

What happens to the chancre? 

It gradually heals

109

When does the second stage of a syphilis infection occur? 

6 to 8 weeks later

110

What happens in the second stage of a syphilis infection? 

  • Fever
  • Rash
  • Lymphadenopathy
  • Mucosal lesions

 

111

Describe the rash in stage 2 syphilis? 

Can develop anywhere, in any shape/form

112

Where is the lymphadenopathy in stage 2 syphilis? 

Local area around the groin 

113

What is the third stage of syphilis? 

Latent, with disease three years

114

What may syphilis develop into in its final stage? 

  • Neurosyphilis
  • Cardiovascular syphilis
  • Gummas

115

What are gummas? 

Local destruction 

116

How is congenital syphilis prevented? 

Screen pregnant women to ensure that they don't have undetected syphilis that could be passed on to child

117

What is the problem with diagnosis of syphilis?

Organism can't be grown, apart from in foot pads of various animals, and then must be looked at using dark-field microscopy

118

How is syphilis diagnosed? 

Serology; initial screening with EIA antibody test, and then for people who test positive; 

  • Rapid Plasma Reagin (RPR) titre 
  • TP particle agglutination (TPPA)

 

119

What is done with the serology of a patient with suspected syphilis? 

The serological pattern is interpreted, including false positives and response to treatment

120

How is syphilis treated? 

Pencillin and 'test of cure' follow up to ensure serology is improving

121

How is syphilis screening conducted? 

Detects possibility, then go on to do more specific test

122

What may inguinal lymphadenopathy be caused by? 

  • Lymphogranuloma venereum (LGV)
  • Chancroid (Haemophilus ducreyi)
  • Granuloma inguinale/donovanosis (Klebsiella granulomatis)

 

123

What causes LGV? 

C. trachoma serotypes L1, L2, L3

124

What does LGV cause? 

Rapidly healing papules (raised lumps) leading to inguinal bubo (abscess)

125

Where have there been recent clusters on LGV? 

Europe, with MSM 

126

What is Chancroid? 

Painful genital ulcers

127

What happens in granuloma inguinale/donovanosis? 

Genital nodules leading to ulcers

128

What kind of pathogen is trichomonas vaginalis? 

Flagellated protozoan

129

How is tricomonas vaginalis spread? 

Normally by sexual route

130

What is the relevance of males in trichomonas vaginalis? 

They are involved in transmission, but not really affected by it 

131

What does trichomonas vaginalis cause? 

Trichomonas vaginitis

132

What are the symptoms of trichomonas vaginitis? 

  • Thin, frothy, offensive discharge
  • Irritation
  • Dysuria
  • Vaginal inflammation 

 

133

How is trichomonas vaginitis diagnosed? 

Vaginal wet preperation, with or without culture enhancement 

134

How is trichomonas vaginitis treated? 

Oral metronidazole

135

What is vulvovaginal candidiasis caused by? 

Candida albicans, or other candida species

136

Where may candida albicans, or other candida species, come from? 

May be part of normal GI and genital tract flora, commonly present in very small numbers

137

What are the risk factors for vulvovaginal candidiasis? 

  • Antibiotics
  • Oral contraceptives
  • Pregnancy
  • Obesity
  • Steroids
  • Diabetes

 

138

What does vuvlovaginal candidiasis cause? 

Profuse, white, itchy, curd-like discharge

139

How is a diagnosis of vulvovaginal candidiasis made?

Usually made by looking at discharge, and based on symptoms, but can also be made by a high vaginal smear, with or without culture

140

How is vulvovaginal candidiasis treated?

  • Topical azoles or nystatin
  • Oral fluconazole

 

141

What can scabies affect?

Genitalia

142

How can scabies be spread?

Sexually

 

143

Are pubic lice distinct from other human (body) lice?

Yes

144

What causes bacterial vaginosis?

Pertubed normal flora

145

Disruption to what normal flora can cause bacterial vaginosis?

  • Gardnerella
  • Anaerobes
  • Mycoplasmas

 

146

What is the disruption of normal flora in bacterial vaginosis usually due to? 

Change in pH 

147

What are the symptoms of bacterial vaginosis?

Scanty but offensive fishy discharge

148

How is a clinical diagnosis of bacterial vaginosis made?

  • Vaginal pH >5
  • KOH whiff test

 

149

How is a laboratory diagnosis of bacterial vaginosis made? 

HVS Gram stained smear

 

150

What features on a HVS gram stained smear are diagnostic of bacterial vaginosis?

  • 'Clue cells' 
  • Reduced number of lactobacilli
  • Absence of pus cells

 

151

What are clue cells? 

Epithelial cells studded with gram variable coccobacilli

 

 

152

How is bacterial vaginosis treated?

Metronidazole